<fieldset class="layui-elem-field">
    <legend>健康体检</legend>
    <div class="layui-row">
        <div class="layui-form-item">
            <div class="layui-inline">
                <label class="layui-form-label">定点医疗机构<span style="color: red">*</span></label>
                <div class="layui-input-inline">
                    <layui:simpleDictSelect style='layui-input-inline' type="medicalInstitutionType"
                                            id="medicalInstitution" name="medicalInstitution"
                                            layVerify="required" value="${medicalCare.medicalInstitution}" />
                </div>
            </div>
            <div class="layui-inline">
                <label class="layui-form-label">体检类别<span style="color: red">*</span></label>
                <div class="layui-input-inline">
                    <input type="text" id="medicalCategory" name="medicalCategory" value="${medicalCare.medicalCategory}" readonly="true" lay-verify="required" class="layui-input input-readonly">
                </div>
            </div>
        </div>
    </div>
    <div class="layui-row">
        <div class="layui-form-item">
            <div class="layui-inline">
                <label class="layui-form-label">体检时间<span style="color: red">*</span></label>
                <div class="layui-input-inline">
                    <input type="text" id="applicationTime" name="applicationTime"  value="${medicalCare.applicationTime,"yyyy-MM-dd"}"   class="layui-input input-date" >
                </div>
            </div>
            <!--<div class="layui-inline">-->
                <!--<label class="layui-form-label">服务结束时间<span style="color: red">*</span></label>-->
                <!--<div class="layui-input-inline">-->
                    <!--<input type="text" id="serviceEndTime" name="serviceEndTime"  value="${medicalCare.serviceEndTime,"yyyy-MM-dd"}"   class="layui-input  input-readonly" readonly>-->
                <!--</div>-->
            <!--</div>-->
        </div>
    </div>
</fieldset>
<fieldset class="layui-elem-field">
    <legend>配偶信息</legend>
    <div class="layui-row">
        <div class="layui-form-item">
            <div class="layui-inline">
                <label class="layui-form-label">配偶姓名<span style="color: red">*</span></label>
                <div class="layui-input-inline">
                    <input type="text" id="spousenName" name="spousenName" value="${medicalCare.spousenName}" lay-verify="required" class="layui-input">
                </div>
            </div>
            <!--<div class="layui-inline">-->
                <!--<label class="layui-form-label">证件号码<span style="color: red">*</span></label>-->
                <!--<div class="layui-input-inline">-->
                    <!--<input type="text" id="spouseNumber" name="spouseNumber" value="${medicalCare.spouseNumber}" lay-verify="required" class="layui-input">-->
                <!--</div>-->
            <!--</div>-->
        <!--</div>-->
    </div>
    <div class="layui-row">
        <div class="layui-form-item">
            <div class="layui-inline">
                <label class="layui-form-label">工作单位<span style="color: red">*</span></label>
                <div class="layui-input-inline">
                    <input type="text" id="spousenWork" name="spousenWork"     value="${medicalCare.spousenWork}"  lay-verify="required" class="layui-input ">
                </div>
            </div>
            <div class="layui-inline">
                <label class="layui-form-label">性别<span style="color: red">*</span></label>
                <div class="layui-input-inline">
                    <layui:simpleDictSelect style='layui-input-inline' type="gender"
                                            id="spousenSex" name="spousenSex"
                                            value="${medicalCare.spousenSex}" layVerify="required"/>
                </div>
            </div>
        </div>
    </div>
    <div class="layui-row">
        <div class="layui-form-item">
            <div class="layui-inline">
                <label class="layui-form-label">联系电话<span style="color: red">*</span></label>
                <div class="layui-input-inline">
                    <input type="text" id="spousenPhone" name="spousenPhone"     value="${medicalCare.spousenPhone}" lay-verify="required" class="layui-input ">
                </div>
            </div>
            <div class="layui-inline">
                <label class="layui-form-label">出生年月<span style="color: red">*</span></label>
                <div class="layui-input-inline">
                    <input type="text" id="spousenBirthday" name="spousenBirthday" value="${medicalCare.spousenBirthday," yyyy-MM-dd"}" class="layui-input input-date" >
                </div>
            </div>
        </div>
    </div>
    <div class="layui-row">
        <div class="layui-form-item">
            <div class="layui-inline">
                <label class="layui-form-label">特殊情况说明(最多100汉字)</label>
                <div class="layui-input-inline">
                    <textarea id="specialInstructions" name="specialInstructions"   class="layui-textarea" style="width: 740px" maxlength="200">${medicalCare.specialInstructions}</textarea>
                </div>
            </div>
        </div>
    </div>
</fieldset>
<fieldset class="layui-elem-field">
    <legend>材料信息</legend>
    <span style="color: red;margin-left: 30px;font-size: 18px">支持文件格式为：pdf,jpg,png,gif，单个文件大小不超过20M。带*号标识的对应资料必须上传，其它资料不作要求。上传文件内容请确保真实清晰、有效，不能有旋转。上传后请查看预览，正确无误后再申报提交。</span>
    <div class="layui-row">
        <label class="layui-form-label file-upload">身份证件<span style="color: red">*</span></label>
        <layui:attachment name="Idfile" batchFileUUID="${medicalCare.Idfile}" isNew="false" bizType="User"/>
    </div>
    <div class="layui-row">
        <label class="layui-form-label file-upload">结婚证件</label>
        <layui:attachment name="otherMaterials" batchFileUUID="${medicalCare.otherMaterials}" isNew="false" bizType="User"/>
    </div>
    </fieldset>
<!-- 业务对象须有hidden字段，保存delFlag和version字段-->
<input type="hidden" name="delFlag" value=${medicalCare.delFlag} />
<input type="hidden" name="id" value=${medicalCare.id} />